Newport Visual Arts Center Art Camps
Summer 2019 Registration Form
Fields marked with * are required. Your registration is not complete until a screen appears thanking you for your registration. If this does not appear, scroll up and confirm all required questions have been answered.
Camp Choice *
Please contact me about scholarships *
T-Shirt Size *
Student name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Parent(s)/Guardian(s) name *
Your answer
Email Address *
Your answer
Primary phone *
Your answer
Secondary phone
Your answer
Emergency contact name *
Your answer
Emergency contact primary phone *
Your answer
Emergency contact secondary phone
Your answer
Dietary restrictions *
Medical conditions and allergies *
Anything we need to know regarding child/or special considerations. *
I understand that I need to send student to camp with lunch *
MEDICAL RELEASE I agree to allow my child to receive medical treatment, should the need arise. I also give permission for my child to be transported to the nearest hospital in the event of a medical emergency. As parent and/or guardian of the above named child, I promise to hold Oregon Coast Council for the Arts harmless from any liabilities it may incur from the above named minor in connection with participation in art classes except as might arise because of negligence on the part of the Oregon Coast Council for the Arts.
Parent/Guardian Name *
Your answer
Child Name *
Your answer
Typing my name below will constitute by signature *
Your answer
Relationship to child *
Your answer
Date *
MM
/
DD
/
YYYY
PHOTO RELEASE I give permission for my child to be photographed and/or videographed in Oregon Coast Council for the Arts activities. I understand and agree that all rights to these photographs and videos are reserved by and shall become property of the Oregon Coast Council for the Arts, and may be used by the Oregon Coast Council for the Arts, for promotion and publicity by the Oregon Coast Council for the Arts, including on the website, in print media, on television or online. *
How did you hear about Art Camp *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service